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Mandatory Nurse Ratios – Good for Massachusetts?

Posted on October 18, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

On November 6th, Massachusetts will vote on mandatory nursing levels. Proponents cite burnout, injuries and patient safety as reasons to vote YES. Opponents claim ERs wait times will rise, small hospitals will close and patient bills will increase.

There is no better way to get a sense of what is on the minds of healthcare leaders than talking with fellow conference attendees. At the recent SHSMD18 event, I had the opportunity to attend a social gathering hosted by the New England Society for Healthcare Communications (NESHCo). There was one topic that dominated the discussion – the upcoming vote on November 6th on mandatory nursing levels in Massachusetts.

Mandatory nurse ration has been a hotly debated issue in the state. Voters will now decide if the state will forge ahead with plans to “limit how many patients could be assigned to each registered nurse in Massachusetts hospitals and certain other health care facilities.”

The proposed MA law sets specific limits on the patient-nurse ratio. For example:

  • 3 patients per nurse in units with step-down/intermediate care patients
  • 1 patient under anesthesia per nurse in units with post-anesthesia care or operation room patients
  • 5 patients per nurse in units with psychiatric or rehabilitation patients

The vote has pitted the Massachusetts Nurses Association (the nurses union, MNA), which strongly supports mandatory nurse ratios, against the Massachusetts Health and Hospital Association (MHHA).

The MNA cites numerous studies, like this one from 2016, that shows for every patient added to a nurse’s workload, the likelihood of a patient surviving cardiac arrest decreases by 5% per patient. And  this one from 2017, that concluded “Exposing critically ill patients to high workload/staffing ratios is associated with a substantial reduction in the odds of survival.”

The MNA has mounted a sizeable campaign to convince MA voters to vote YES. Their website, is full of interesting articles, stories from frontline nurses and quotes from physicians that support the measure.

The MHHA, on the other hand, is encouraging a NO vote. They acknowledge that nursing levels need to be monitored but imposing strict limits based solely on the unit or patient type will cost nearly $900 million every year. According to the MHHA, patients would end up footing the bill through higher healthcare costs.

The MHAA also claims that specifying the maximum number of patients for each nurse, effectively puts a cap on the number of patients a hospital can accept in their ERs – resulting in longer wait times.

For an excellent overview of the law and the arguments both for and against Question 1, check out this excellent article by Boston’s local NPR station – WGBH. The article also has information about the impact mandatory nurse ratios has had in California which enacted a similar law back in 1999.

What I found fascinating about the discussions with NESHCo members was how hospitals in neighboring states were also voicing their concerns on Question 1. If MA was to mandate nursing ratios, that state’s hospitals would suddenly need to hire thousands of nurses in order to comply with the new law. Where would these nurses likely come from? You guessed it, neighboring states like New Hampshire, Maine, Vermont and Connecticut. It’s easy to see why hospitals in those states would be worried.

I honestly don’t know which way I would vote.

On one hand the current working condition for nurses is unsustainable. Nurses are often asked to work longer shifts because hospitals can’t fill open nursing positions fast enough and most are expected to work without breaks. Could you imagine working 12hrs or more without being able to eat or go to the restroom? 70% of nurses are already feeling burnt out in their current positions. Clearly the status quo isn’t working.

On the other hand, there is currently no provision in the law to adjust the nursing ratios as technology advances. New York Presbyterian Hospital, for example, has built a remote patient monitoring center that tracks patient vitals in real-time. Using a combination of AI, specialized technicians and remote nurses, this “command center” can alert the local nursing staff when a patient may be experiencing an issue. Armed with this technology, not only are patients safer but on-site nurses can spend more time with each patient in their unit. The MA law would have the unintended consequence of squashing investment in this type of technology since staffing levels could not be significantly adjusted.

For more on this topic, take a look at the transcript for this week’s HCLDR chat. Government regulation is also the topic for this weeks’ #HITsm chat hosted by John Lynn. Join the discussion Friday 10/19 at noon ET.

Nurses need help. Mandatory nursing ratios is one possible solution. However, I’m not sure legislation is the best way to improve the nursing situation.

Rolling Over Mountains – An Interview with Niko Skievaski, President of Redox

Posted on October 16, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Over the past year I have been following the success of Redox and I have read many articles about the entrepreneurial journey of their President and Co-Founder, Niko Skievaski. I recently had the chance to sit down with him at the MGMA18 conference in Boston.

Rather than revisit the same questions that have been covered in dozens of other articles, I wanted to go in a different direction. I wanted to learn more about Skievaski- the-person rather than Skievaski-the-entrepreneur and I wanted to hear Skievaski’s opinion on the state of the healthcare as an ecosystem.

The latter is something that we have been investigating here at Healthcare Scene. For more details, see John Lynn’s recent post about MEDITECH’s app development environment (Greenfield) and my article exploring whether EHR companies are difficult to work with.

Skievaski and I had a wide-ranging conversation. I hope you enjoy it.

You and I met briefly at the Redox party at HIMSS18 earlier this year. I just want to thank you for your hospitality.

You’re welcome. We love our taco parties at Redox. I’m glad you enjoyed the fiesta.

I understand that you recently moved from Madison, WI to Boulder, Colorado. Why the move?

I lived in Madison for 10 years. I was working for EPIC during that time so it made sense to be there. But I recently decided that I needed a few more mountains in my life so I moved to Boulder.

All through college I raced mountain bikes and I wanted to get back to that. Madison does have a few rolling hills which are fun to ride down, but there’s no comparison to biking down a mountain. So I moved to Boulder for the mountain biking.

You’re from Canada right? [Yes] I was up in British Columbia for two months in the summer last year just mountain biking the trails up there. That was my first real experience being in Canada for an extended period of time. It was fun. You guys are really chill up there in Vancouver.

There are many players in the data integration space. Some have been in the business for decades. Why has Redox succeed in capturing the buzz while others haven’t?

We do things fundamentally differently than existing vendors in the integration space.

In the status quo, you implement an EHR and you need upwards of 400 interfaces to connect it to various other systems in your hospital. So you go out and hire 5-20 interface analysts to sit around all day and code the interfaces you need. You do that a few times, like we did at Epic, and you realize that you are building the same interface over and over again for different health systems. It is literally is the same interface.

Redox is based on the premise that you only should have to build the interface once for all healthcare systems. Once it’s built, others can leverage that work too. For example, we connect Brigham and Women’s ADT feed to Redox. We mapped it. We know where all the fields are. And we’ve done the same with hundreds of other health systems. So if there is any reason that Brigham wants to share their info with any of those other health systems we can facilitate it very easily.

Legacy players didn’t grow up in the cloud so they don’t think like we do. They come from a world of on-premise integration and at a time when healthcare organizations wanted to do all the interface work themselves. It’s a different world now.

I guess you can say that we’re getting the attention because we are solving the problem so differently than everyone else.

One of the interesting things about Redox is that you don’t sell to healthcare organizations. Instead you focus exclusively on HealthIT vendors. Why is that?

We started by working with HealthIT startups that knew how to build in the cloud but didn’t know anything about HL7 and didn’t want to. Yet these companies needed to connect to their customers’ EHR systems.

Without that integration, healthcare organizations wouldn’t buy these amazing cloud apps because of the lack of easy connectivity to their existing systems. In that equation, the incentive lies with the HealthIT company. They are the ones that want to solve the issue of connectivity more than the healthcare organization does. So we target companies that need this help and we go to their customers, get connected to the data and make It easy for the new company to focus on what they do best – which isn’t data integration.

The first project we do with a health system is very much like a standard integration project. The second project is where things get excited because we use that exact same interface we built the first time. There’s really no work to be done by the organization. That’s how we scale.

Is there an ideal type of HealthIT company that Redox likes to work with?

With certain vendors who have the right multi-tenant architecture, like PointClickCare, we can just connect with them once and they can then provision to their customers with a flip of a switch. Any PointClickCare location that wants integration, they can just click and make it happen. Together we make it very easy for a PointClickCare customer to connect with HIEs and the healthcare organizations that they work with.

Basically any HealthIT vendor that is truly cloud-based and that has embraced the concept of having a single platform for everyone is an ideal fit for Redox. Of course, we’re willing to talk to anyone to try and find a solution, but if you are cloud-based HealthIT vendor we should really be talking.

Can you give me an example of an advantage Redox enjoys because you are cloud-based?

By being in the cloud we essentially become the cloud interface for health systems to connect to cloud apps. Vendors come to us because we make it easy for them to get the data they need. Healthcare organizations push cloud vendors they want to work with to us because they won’t have to do any work to connect that new app if that vendor signs on with Redox.

Where things get really interesting, and exciting for Redox, is when we can use our cloud platform to facilitate conversations between vendors and their common customers without the need to go all the way back to that customer’s EHR as the focal point of integration.

For example, say there is a cloud-based scheduling app that allows patients to see and book appointments online. Let’s say they are a Redox customer. Now let’s say there is a telemedicine app that allows healthcare organizations to offer telehealth visits and it reads/writes appointment data directly into the organization’s EHR. Say this telemedicine company is a Redox customer too. So if the healthcare org wants to offer Telemedicine appointments through that scheduling app, the two companies can just integrate through Redox rather than use the EHR as the point of integration because we have all the necessary information running through our platform. This would speed up the transaction and make the patient experience more seamless.

This level of integration is just not possible without being in the cloud.

One of the topics we have explored recently at Healthcare Scene is how difficult it is (or isn’t) to work with EHR companies like Epic, Cerner and Allscripts. What are your thoughts on this? Are EHR companies hard to work with?

I would say, in general, EHR companies get a bad rap. I worked at Epic and I have to say that being inside Epic you don’t realize that people outside think you are difficult to work with. We worked hard to give our customers good service. Epic supports their customers, which are health systems. If a system wants to integrate with an application, then Epic people are more than happy to make it happen. They will put together a project team to support that initiative.

I think that as long as the health system is driving the conversation, EHR companies can be easy to work with.

The challenging part is when there is no customer in between. Say you are a HealthIT vendor and you want to go strike up a deal with an EHR company, like Epic. You have to realize that it’s nearly impossible for that EHR company to assess you as HealthIT vendor. They can’t tell if you are a good vendor or a bad one. If you are an established player or someone with an idea on the back of a napkin. The only way they can tell is if they go ask their customers – the health systems. Because of this, their traditional response has been: “Yes, happy to work with you, but we need to have one of our customers on board to prove this will work.” This can be perceived as being difficult to work with.

When we started Redox we didn’t go immediately knocking on Epic’s door and asking our friends to partner with us. Instead we went out and found a mutual customer to work with so that we would have a proof point when we did approach them.

I actually think it is easier to work with large EHR companies versus smaller ones. The larger companies have more invested in each of their customers and are more apt to work on projects that their customers want to do. Smaller EHR companies are constrained by resources and often don’t have the infrastructure to support integration projects in a timely manner. The good news is that things are changing. We’re seeing a lot more of the small EHR companies come out with developer programs, APIs and partner exchanges. I think they understand the need for their systems to be open.

Is the lack of interoperability a technological issue or is it simply an unwillingness to collaborate?

Neither. It’s a business model problem.

There is no business model that drives healthcare organizations to share their data. No one bats an eye about the lack of interoperability in the consumer world. Walmart doesn’t share their customer data with Target even though there are many people buy from both retailers. If they did share data, they would just be stealing each other’s customers. Healthcare organizations are in competition with each other so they aren’t really incentivized to share data with each other, but give them a useful app in between and all of a sudden they will open up their data.

Interoperability is the right thing to do, but it’s a hard thing to do.

What do you wish you could do with an EHR company that you cannot do today?

The user interface (UI) of EHRs are locked down. I wish EHR companies were more open to change workflow or add buttons to their UIs to make things a more seamless.

I totally understand why they don’t allow it. The workflow in an EHR has an impact on patient safety as well as on outcomes, so you wouldn’t want just any vendor to be able to make UI changes on a whim. But it would be great if there was a way to do something with the UI to make it easier for the end user.

For example, if you are doing something in the workflow, it would be fantastic if you could add a button to the UI that launched a 3rd party app from within the EHR. Say a clinician is doing a chart review and they want to be able to see the latest data from a remote patient monitoring tool. Imagine if that clinician could click a button and launch the actual monitoring app rather than that app having to ship its data to the EHR and have it stored/rendered in a poor format – like a table of numbers or a rudimentary chart. Why not let the native app show the data in all it’s glory using an interface designed specifically for it?

What’s next for Redox?

We want to push the healthcare industry to a point where we don’t even think about integration anymore. We want to see an end to integration projects. Think about all the time and resources that would be saved if you don’t have to use a custom interface each time. If we can do that we can drive down the cost of healthcare for everyone. To do that we just have to keep growing the nodes on our network and be a good partner to everyone.


This may sound like a tall order, but maybe not for someone who rolls over mountains on a bike for fun.

[Update: Niko Skievaski’s title which was incorrectly reported as CEO. Skievaski is Redox’s President and Co-Founder]

MGMA 2018 Keynotes Hit Back-to-Back Home Runs

Posted on October 2, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Not far from legendary Fenway Park, MGMA hit back-to-back home runs with their opening keynotes: Simon Sinek and Mel Robbins. Both had us completely enthralled and hanging on their every word. It was an incredible way to start a conference.

I have never been more excited for a set of keynotes than I have for the 2018 MGMA Annual Conference #MGMA18Annual. When the agenda for the conference was officially released I was pleasantly surprised to see not one, but TWO well-known keynote speakers.

Simon Sinek is best known for his TEDTalk – “How great leaders inspire action” which became one of the most popular ever produced. In it Sinek talks about getting past WHAT you offer and HOW you offer it in order to reach the crucial WHY you do what you do. It is one of my favorite videos to watch.

Sinek’s #MGMA18Annual keynote was based on his latest work on Finite vs Infinite Games of Leadership. For a preview you can watch this video of his presentation at Google.

According to Sinek a finite game is one where there known players, fixed rules and an agreed upon objective. Baseball, football and hockey are classic examples of finite games. Infinite games, have known and unknown players, changeable rules and the objective is to keep the game going. With infinite games there are no winners or losers. The only way the game ends is when the second-to-last player loses the will or the resources to continue playing the game.

Sinek used the Cold War as an example of an infinite game. The Soviet Union was the second-to-last player and they dropped out when they lost the will and the resources to keep playing. Sinek warns that when you pit a finite player vs an infinite player you are in fact playing an infinite game and inevitably the finite player loses. That is because the finite player is playing to WIN whereas the infinite player is playing to keep playing. Sooner or later the finite player will drop out – not prepared to dedicate as much resources to the game as the infinite player.

Sinek applied this finite vs infinite game analogy to business and found that too many companies are finite players in an infinite game. “We talk about being number 1.” said Sinek. “We boast about beating the competition, but in fact that isn’t the case at all in business. There is no winner. You are either ahead or behind, but you can’t actually win in the game of business. You just have to keep playing.”

According to Sinek, one of the keys to succeeding in an infinite game is to have a Just Cause. Such a cause will help you rally the necessary resources and will to keep playing the game. Ending child poverty, and making the sum total of human knowledge searchable are examples of Just Causes.

Healthcare clearly has a Just Cause – to help people live longer, healthier lives. So why is healthcare in such a quagmire? (something Sinek claims is typical of finite players in an infinite game). This was one of the questions posed by a member of the audience at #MGMA18Annual. Sinek’s answer was brilliant.

“I believe that the problem in healthcare is that many organizational leaders have mistakenly taken the industry’s Just Cause and made it their own. Healthcare as industry is supposed to keep people healthy. However, the job of the leaders of healthcare organizations isn’t to make people healthy. No! Their job is to take care of the people who deliver care to patients.”

Imagine how different healthcare would be if administrators, healthcare leaders and government officials all had the same goal: taking care of the physicians, nurses and support staff under their influence. Think about the level of care a patient would receive if the doctor and the nurse felt that the organization they worked for had their back? How different would the patient experience be?

Home Run #1.

Mel Robbins, #MGMA18Annual’s second keynote speaker, kicked off Day 2 of the conference with a rousing session centered on her transformative 5 second rule. Her simple rule has helped people stay sober, save their marriages and turn-around failing careers. The rule is so simple that she felt obligated to call it out in her opening: “After I tell you the secret of the 5 second rule, most of you will likely say to yourself – that can’t possibly work, but trust me it does. And that’s the beauty of it, it’s simple.”

In a nutshell, Robbins method involved counting down from 5 whenever you find yourself starting to have a negative thought or when you feel yourself making an excuse NOT to do something you know you should.

Roll out of bed and see your running shoes, but then look outside and see that a few dark clouds. Don’t let the excuse fully form in your mind. Instead, change your mental soundtrack by counting down 5 – 4 – 3 – 2 – 1 and then do it. See a task that you’ve been putting off all day, 5 – 4 – 3 – 2 – 1 and dive in. Sounds too simple right?

Robbins spent much of her time on stage giving scientific evidence and examples of how this 5 second rule actually works. She talked about being on “autopilot” – a mental state where your brain falls back on learned behaviour to guide the actions you take. Procrastination and self-doubt are the autopilot settings for most of us. According to Robbins, in order to break free of autopilot, you need to engage your frontal cortex – which is what happens when you count down from 5.

This simple brain hack puts you back in control of your actions and suddenly the excuses melt away and you get on with the necessary task. That essay suddenly gets written, the house gets painted, the phone call gets made and the important email gets sent.

Robbins was quick to point out that her 5 second rule did not apply to life-or-death medical decisions, nor should it be used to make important financial or life-altering decisions. It was meant to be used when we start hearing the voice of our inner doubts.

I must admit that when I first watched Robbin’s TEDTalk I did not internalize her message. I fell into the trap and thought it was too simple to be effective. Hearing her deliver her message live at #MGMA18Annual changed my mind. It’s only been a day but already I’ve used Robbin’s 5 second rule to climb the stairs instead of using the escalators at the convention center, opt for water instead of soda,  and write this blog before going to bed.

Home Run #2

Thank you MGMA organizers.

2018 Thrival Festival. Are We Asking the Right Questions?

Posted on September 26, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Presentations in a botanical garden. Workshops in an actual work shop. Disco in a museum. The 2018 Thrival Festival eschewed tradition and challenged attendees to ponder: Are we asking the right questions when it comes to humanity + technology + art?

The annual Thrival Festival held in Pittsburgh PA is truly unique. It combines art, technology, philosophy, music, and yes, even healthcare, into an event that is part science fair and part theatre. Instead of holding the event in a traditional auditorium or hotel, the organizers chose the beautiful Phipps Conservatory and Botanical Gardens as the setting for this year’s event.

Rising like a glass armadillo out of lush grass splashed here and there with colorful flowers, the Conservatory welcomed attendees with a warm scent of green leaves and rich earth. It was immediately apparent we were in for something different as we passed through the mammoth glass entryway and wound our way through the maze of monarchs and waterfalls to reach the main session room.

With sunshine and mother nature as a backdrop, Thrival kicked off with a keynote from John Battelle @johnbattelle, CEO and Editor-in-Chief of WIRED. Battelle wasted no time in setting the tone for the day. Early in his presentation he put up the following picture from National Geographic with the caption: What makes us human?

© Martin Schoeller/National Geographic

The image was from National Geographic’s October 125th anniversary issue (2013) where they photographed the new faces of America – a reflection of the blurring of traditional racial and ethnic lines. Battelle used the slide to highlight that society will soon be challenged to define humanity more broadly than before – as we manipulate our genes, embed technology into our bodies and program human-like qualities into robots.

Later in the morning, the issue of do-it-yourself implantable devices and pseudo-scientific injectable cocktails was discussed by a panel of experts. Dr. Rasu Shrestha @RasuShrestha was asked: Is biohacking the future of medicine? With a smile and wink, he deftly answered the question by putting forward the notion that the original healers and physicians were themselves the biohackers of their day. Instead of nanobots they used herbs and crude instruments to try and cure our pre-industrial ancestors.

*Yes, Rasu did use “OG” in his answer, to the delight of the audience.

The panel also featured Rich Lee @lovetron9000 the controversial sex technologist who not only installed a vibrating implant in himself but also recently self-injected a gene therapy that he hopes will cure him of his color blindness. Vilified by authorities, Lee was decidedly normal both on and off the stage answering questions about his motivations.

Over lunch I had the opportunity to chat with Laura Montoya, Founder of Accel:AI and Director of Women Who Code. Montoya teaches development teams to consider the ethical issues relating to AI algorithms. She posed the most interesting question of the day: Would you get into a self-driving car if you knew the algorithm governing it would choose to save the life of a pedestrian over you the passenger?

“Think of it this way,” explained Montoya. “When you sign up for a ride-sharing service, you have to agree to the company’s terms of use. Buried in that agreement is a waiver of liability. Essentially you as an individual are opting into the fact that you are okay with being driven around by a computer rather than an actual driver. The liability of the company for you is therefore limited. Now think about the pedestrian. They have not opted into the company’s self-driving car. They have not agreed that a self-driving car should be in their neighborhood. Therefore, the pedestrian represents a potentially high financial liability – being an innocent bystander. So if the car is faced with the choice of crashing into the pedestrian vs crashing into a tree, would the difference in the degree of liability influence it’s decision. And if it did, would you have knowingly gotten into the vehicle in the first place.”

*Note to self, uncheck the self-driving option from my Uber app.

My Thrival afternoon began with a short viewing of GAPPED – a documentary from Molten Media Group. The excerpt contained powerful and moving interviews of Pittsburgh residents who were in danger of being left behind by the innovation boom that the city is currently enjoying. After the screening, the producers of the film shared that they were seeking to answer a single question: Will Pittsburgh and its people have the chance to rise together or will those unwilling to adapt be left behind?

To me the film asks a much broader question: What happens when innovation wealth is unequally distributed within an ecosystem? And I don’t mean the spoils of innovation like money, equity stakes and fancy offices. What happens when public and private programs inadvertently leave out a portion of the local population? Is it fair that 95% of the innovation seed funding goes to middle-class college graduates while innovators living under the poverty line struggle to keep afloat? I can’t wait to see the entire film when it is released later this year.

I decided to end my Thrival day by attending the Moonshot Workshop led by the XPRIZE Foundation – the people behind the space competition that spawned Virgin Galactic and SpaceX. The workshop started with a short presentation by Amir Banifatemi, AI Lead at XPRIZE. Banifatemi explained the process they go through to curate, refine and define the incentive competitions that “entice the world to take action”. It turns out that it takes the team at XPRIZE over nine months to clearly define one of their challenges.

“If we define the challenge too broadly, teams become overwhelmed with where to start.” Said Banifatemi. “Problems need to be specific enough to spark the imagination but not so blue-sky that people get lost in the possibilities. If we make our challenges too difficult, we may discourage people from entering. It turns out that coming up with the right question, the right challenge is almost as hard as solving it. But if you get the question right, magic happens.

Banifatemi’s statement was the perfect bow on my day at Thrival Festival. Before innovation can happen, a problem or challenge must first exist. Once we understand that problem, our collective imaginations can be unleashed. Better definition of the problem leads to better innovation. The question of: “How can we look inside the human body?” begat X-ray machines. The more refined question of: “How can we look inside the human body without causing harm to the person and with sufficient detail to see tissue?” begat MRI machines (okay maybe a bit of a stretch, but you get the idea).

As the high-energy techno anthems from Veserium washed over me at the Thrival evening event, I found myself thinking about all the questions we are asking in healthcare. Perhaps we need to take a moment and ask ourselves if we are really asking the right ones.

Are EHR Companies Difficult to Work With?

Posted on September 10, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

There is an entrenched myth that EHR companies are difficult to partner with – more interested in up-front partner fees and revenue sharing than actually collaborating with 3rd party companies. Two companies are working hard to be different.

Early in the spring, I had a lengthy conversation with a group of vendors at HIMSS18 about partnering with EHR companies. I had stopped at a booth and somehow we got onto the topic of collaborating with EHR companies as a way to accelerate product development and sales. The person I was speaking with was very frustrated at the lack of response from three of the larger EHR companies. I’m paraphrasing, but her statement was essentially this: “All they want is to charge me their 5K partnership fee and then take 10% of everything I sell to their customer base. It’s ridiculous.”

At that point, several representatives from surrounding booths joined in our conversation. All of them had similar frustrations and shared similar stories of being shunted to the partnership team – which in their opinion was just a sales team in disguise – where they were told about all the wonderful benefits they would receive in return for an upfront partnership fee. I’m sure many Healthcare Scene readers can identify with these vendors.

This conversation stuck with me and over the spring and summer, I decided to dive deeper into the world of EHR partnerships. I wanted to know if the myths were true and I wanted to see if there were any companies that were operating differently. Over the past several months at every conference I have attended, I have made it a point to find out as much as I could about the various partnership programs and spoke with dozens of vendors who were proudly displaying partnership badges on their booths.

The good news is that there are at least two companies working hard to build a thriving partner ecosystem. The bad news is that many EHR companies do not have a well-defined partnership strategy and many vendors do not feel they are getting full value for their participation in EHR ecosystems.

One of the key things I learned is that there is a distinct difference between working with an EHR company on interoperability vs being part of their partner ecosystem. There have been many articles over the past few years about the difficulty of extracting data from EHRs in order to share it with other organizations involved in the care for patients. Headlines like “How disparate EHR systems, lack of interoperability contribute to physician stress, burnout” are common.

Many of the EHR companies I spoke with separate their interoperability efforts from their partnership programs. The ability to share data with others, they said, was not related to how well/not well they worked with 3rd party companies. So while it may be true that EHR companies have a lot of work to do on interoperability, partnership for some is something a few companies are doing well.

One company is Allscripts.

After HIMSS18, I had the opportunity to drop in on the fourth annual Allscripts Developer Summit in Chicago. I honestly did not know what to expect and I was pleasantly surprised at how intimate the event was. The rooms were smaller and had people sitting at round tables listening to presenters and asking lots of questions. The level of interaction between the speakers and the developers at the tables was refreshing to see.

Most of the attendees at the Summit were developers and product managers from companies that were Allscripts partners. Most of the discussions in the sessions and in the hallways centered around the latest APIs and FHIR initiatives.

The Summit is part of Allscript’s Developer Program (ADP). Allscripts recently announced that its ADP partners have together processed more than 4 Billion API data exchange transactions since the company started tracking it in 2013. In the announcement Tina Joros, VP and General Manager, Open Business Unit at Allscripts had this to say:

“We are trying to create a new mentality of innovation for our clients so that they view innovation as a path to improve overall workflows and connect with patients. We have made our API platform easily accessible and cost-effective for developers to use so that they can develop and test their solutions. This includes the ability for developers to use our FHIR APIs to meet regulatory requirements for our shared clients at no cost.”

I had the chance to sit down with Joros during the Summit and she shared with me that Allscripts does more than just provide access to their APIs. “We help companies with sales and marketing as well,” said Joros. “We coach partners that are new to the space how to ‘talk healthcare’. We help them craft and tell their stories to their target buyers. We spend a lot of time on the phone and in the field with our ADP partners. Our goal is to reduce the risk for clients to adopt new technology.”

With more than 8,000 registered developers in ADP, I asked Joros why so many companies had joined. “One of the key differentiators is the ADP Integrator tier of our program; most competitors have programs that make it easier to sign up for the FHIR APIs but they also have a vetting process in place to review companies for partnership,” said Joros. “In our ADP Integrator tier, however, companies can sign up immediately to access all our FHIR and proprietary API functionality – there is no wait or vetting by Allscripts and no fee to get started. The pricing model is designed so that companies only pay Allscripts when they are ready to go to market via a testing fee and usage-based fee. The ease of signing up and no fee to get started are unique in the industry.”

One company that has been very successful at working with Allscripts is Relaymed – a company that makes connectivity software that sends point-of-care test results directly into EHRs. RelayMed has been part of ADP for four years and had nothing but good things to say about the program.

“Many EHR companies have rigid cultures that actually bias them against partnerships – the ‘not invented here’ syndrome,” commented Neil Farish, CEO of Relaymed who spoke with me over the phone. “Allscripts isn’t like that. They had a vision of an open and vibrant ecosystem. That vision is ingrained into their culture and there is support right from the top. It’s become part of their DNA. If anything, senior management at Allscripts has been paying even more attention to partners this year. They are present. They interact with us. Help from their marketing & sales teams has been easy to get and really welcomed.”

The team at Relaymed has been working with the Allscripts team to tighten and improve the level of integration between their two systems. As well, the companies together are looking at ways to expand the breadth of devices that connect to Allscripts through Relaymed.

Another company that has invested in their partnership program is Cerner.

Cerner takes a different approach when working with partners. Although they have a centralized team that helps on-board partners (legal, contracting, etc), the ongoing relationship with partners is handled directly by the team/department that works most closely with that partner. Sometimes that is the Cerner sales team. Often times it is the product team. It just depends on where most of the interactions will occur.

“No partnership looks the same,” John Gresham, Senior Vice President, DeviceWorks & Interoperability at Cerner told Healthcare Scene. “So we have to ask the key question – How does that partnership bring differentiated value to the customer? We will work with partners the way that works best for our customers. That may mean embedding someone else’s solution within our solutions, co-market their solution as part of a bundle or we may simply go-to-market together.”

It was surprising to learn that a company as large as Cerner did not have a cookie-cutter approach to partnering with 3rd parties. It would have been easy for them to put in a rigid framework but instead they adapt themselves to best suit the partnership. DellEMC, Kofax and Nuance were cited by Gresham as examples of Cerner partnerships that were flourishing.

“Customers want something seamless and not just in terms of Cerner being a systems integrator for them,” continued Gresham. “They want everything to be smooth and simple – buying it, contracting it, deploying it, integrating it and supporting it. Cerner is willing to do all those things, something that isn’t common in the EHR space.”

During our conversation, Gresham repeatedly referenced Cerner’s laser focus on delivering better patient care and better outcomes – and how that focus guided their partnership decisions. In fact, that is key to attracting the attention of an internal champion at Cerner: a clear line from the product or service being offered to customer or patient benefit.

That is exactly what happened with Goliath Technologies, a provider of IT operations software that enables IT Teams to anticipate, troubleshoot and prevent infrastructure performance issues. The team at Goliath had successfully implemented their solution at a Cerner customer. That customer spoke about their experience at a Cerner event and Jay Savaiano, Senior Director of Business Development at Cerner took notice.

“It was because of Jay and his vision that Goliath got into the program,” explained Thomas Charlton, Chairman and CEO at Goliath Technologies. “He was the first person we had a conversation with and from there everything went smoothly. He was with us every step of the way and we’re still working with Jay today. But it all started because we were able to demonstrate a clear positive impact on a Cerner customer.”

“Once Cerner decided that Goliath would benefit their customers, the process of formalizing the relationship was very straightforward and smooth,” continued Charlton. “They moved really fast. They have a fantastic team of people, very competent and focused. Everyone from contracting to legal to sales was great to work with.”

Because of the success, they have enjoyed with Cerner, Goliath has begun to put a lot of focus on their partnership with Cerner. They have begun working with Cerner developers to refine and tune their combined solutions and Goliath recently hired a new VP of Corporate Development who had left Cerner a few years ago, to help strengthen the relationship [side note the VP was referred to Charlton by people at Cerner]

“Cerner brings healthcare knowledge to Goliath,” said Charlton. “They know patient care and healthcare systems management. That deep understanding of healthcare has helped us with product development. Cerner has really helped to reshape our thinking on healthcare, patient care and Healthcare IT Operations management.”


It is interesting to note that neither Relaymed or Goliath were put forward by Allscripts or Cerner respectively as example partners to speak with. Both Relaymed and Goliath were referred to me by different people who are not affiliated with either EHR company.

So if you are a software provider that is looking to partner with an EHR company what can you do to attract their attention? All four individuals I spoke with offered sage advice.

Neil Farish (Relaymed): “Avoid the transactional models of partnership where it is just an exchange of $$$. Look to the value that you as a partner are getting, the value the EHR company is getting and the value you can provide together to their end-customers. If there is value all around then the fees should be dwarfed by the value. If not, then you seriously have to rethink that potential partnership.”

Thomas Charlton (Goliath): “Have a very clear understanding of how your product or service helps deliver better care to patients. Can you show a direct line to customer or patient benefit? If you can’t then you need to figure that out before approaching an EHR company looking for a partnership. Also, joint customers are important. The more joint customers you have the more momentum you will get behind the initiative.”

John Gresham (Cerner): “The key to making partnerships work is mutual respect. That’s the starting point. Next comes a key question – do you have a ‘what’s best for customers’ mindset. If you have that then we have a foundation for conversation. I would strongly encourage companies to build solutions for the highest possible reliability, scalability and security.  Cerner customers expect that. Oh, and you have to have proof points to back that up.”

Tina Joros (Allscripts): “Be persistent. Come talk to us at conferences. Connect with us online. I would encourage any company signed up for the program and does not feel like it is providing value, to speak with a member of our team and let us know.  In some cases, we can find a tier that is a better fit for the company or make introductions to other associates at Allscripts, so additional areas of the business can evaluate their solution.”

Myth busted.

2018 Health:Further Festival Format Delivers Interesting Takeaways and a Side of Fun

Posted on September 4, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Health:Further delivered interesting takeaways from Walmart, Dell Medical School, Cerner, athenahealth & MEDITECH. The companies are bullish on data analytics, design-thinking and interoperability. Social Determinants of Health remains a challenge.

Last week, I had the chance to attend the 2018 Health:Further event (H:F) for the first time. I say event rather than conference because the latter would not do justice to the non-traditional format of the gathering in Nashville. Instead of the standard plenary+breakouts+exhibit-hall arrangement that is the norm for conferences, H:F used a music-festival approach with multiple stages in a giant exhibit hall. This was a perfect match to the unique venue – Nashville’s Music City Center.

There were four themed stages at H:F

  1. Summit of the Southeast #SOSE18 (hosted by the Tennessee chapter of HIMSS)
  2. Finances and Tokenomics (hosted by the Tennessee chapter of HFMA)
  3. Humanizing Health
  4. Clinicians and Consumers

The music-inspired multiple-stage approach allowed participants to easily and quickly move between talks. Each stage was curtained off with convenient entrances on each side of the seating area. The lack of walls and doors gave the event a dynamic and fluid feeling – with many members of the audience deciding to move to a different stage after listening to the opening statements of the session they were currently watching. Although it may have been disheartening for speakers to see people getting up to leave, in most cases there was an equal flow of people into the audience as were leaving.

Photo by AngelMD:

As a veteran conference attendee, I have no hesitation voting with my feet, but many others do not want to make a scene opening the heavy conference room doors. Most just stay put and check email while the speaker completes the presentation. Neither benefits in that situation and so the H:F organizers overcame this challenge by adopting the festival format.

Over the three days of the event, I had the opportunity to listen to thought-leaders from a number of high-profile companies including Walmart, HCA Healthcare, Dell Medical School, Mass Challenge, the Department of Health and Human Services, Cerner, MEDITECH, and athenahealth. From this outstanding lineup of speakers, several key interesting takeaways emerged.

Data analytics is yielding useful health insights

Marcus Osborne, Vice President of Health & Wellness Transformation at Walmart, spoke about the retail giant’s use of consumer purchasing to detect changes in people’s health. The company has done research on the buying patterns of its consumers and they have found that small changes in purchase behavior are strongly linked to changes in a person’s health. The data and linkage is so strong that it may be possible for Walmart to know about it before the person even has had a chance to go see their doctor!

I’m excited to see how retailers like Walmart, Amazon, Target, and others can impact health with this depth of data analysis.

Osborne also spoke about using data analytics to help drive down the cost of healthcare for it’s workforce by guiding people to higher efficacy treatments. Osborne used the term “appropriate care” when describing how data could be used to match employees with the best healthcare professional given that person’s unique health needs. The company estimates this could yield over $1Billion in savings.

Design will be a differentiator

Stacey Chang, Founder & Executive Director of the Design Institute for Health at UT Austin, challenged the audience to think seriously about the role of design in healthcare. He made the case that design-thinking and well-designed healthcare organizations (physically and from a process perspective) will be the winners as the system becomes more value-based and consumer driven.

Chang’s most thought-provoking takeaway was his statement: “To provoke change with technology – allowing humans to interact again”. That is, to truly affect change in healthcare, we need to work on technologies that bring people closer together and allow them to interact with each other, rather than with a computer screen.

Diversity leads to innovation

In one of several all-women panels, the topic of diversity and how different perspectives are needed to improve healthcare was discussed. One panelist spoke passionately about the need for healthcare to be more inclusive of everyone involved in care: patients, care-givers, clinicians, administrators, payors, employers, etc. Another panelist quickly added that diversity of industry and training was also needed – that healthcare would benefit from perspectives from outside the industry and from people with non-medical backgrounds like arts, philosophy and music.

EHR companies can get along (interoperability)

The most memorable (and lively) session at H:F happened on the Summit of the Southeast stage. The team at Tennessee HIMSS managed to get representatives from Cerner, athenahealth, MEDITECH and Medhost on a panel together to talk about interoperability. Right from the first question, we knew we were in for a fun ride:

Greg Meyer @Greg_Meyer93, Director and Distinguished Engineer at Cerner, created the most memorable moment on stage, hugging Evan Grossman who was representing athenahealth after Grossman emphatically stated that patients should “not be the mule that makes interoperability work”:

The panelists spoke at length about practical strategies to achieve interoperability – strategies that did not involve creating yet another standard, government regulations or financial incentives. The consensus of the panel was the EHR companies simply needed to get down to work and make their respective systems talk to one another because it’s the right thing to do.

No argument here.

SDOH remains a challenge

The final takeaway from H:F was that social determinants of health (SDOH) is slowly entering the consciousness of healthcare. More and more people are starting to realize and see that we cannot address health if we do not also address poverty, education, the lack of jobs, transit and food deserts. Unfortunately SDOH solutions are still in short supply. No one I spoke to had any solid ideas that would scale and everyone acknowledged this would continue to be a challenge over the next decade.

Special thanks to the Tennessee HIMSS organization for inviting me to the 2018 Health:Further event.

The Widening Gap in Dementia Care and One Woman’s Crusade to Address it

Posted on June 13, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

According to Alzheimer’s Disease International (ADI), someone in the world develops dementia every 3 seconds. An estimated 50 million people had dementia in 2017. That number is expected to grow to 75 million people by 2030.

In 2017, Dr. Anitha Rao, a board certified geriatric neurologist and CEO of Neurocern, published a paper that highlighted the uneven distribution of trained dementia specialists in the United States. Her paper pointed to 20 States that were “Dementia Deserts” where there was insufficient access to specialists given the number of Dementia patients. Without intervention, this gap in Dementia care will only get wider.

While practicing at UCSF’s renowned Memory & Aging Center, Rao noticed two alarming trends:

  1. The time between booking an appointment and the actual appointment continued to grow
  2. More and more undiagnosed patients were coming in to the Center

ADI estimates that only 20-50% of dementia cases are recognized and documented in primary care. With little training and few resources available to patients, primary care doctors are reticent to tell patients they may have Dementia. Read this excellent, and frightening, article by Alice Park in Time on this topic.

An unfortunate consequence of this delay in diagnosis, was that Rao often had the unenviable job of telling patients and their families that the disease had progressed beyond the early-stage interventions that might have made a difference. Worse, she found that many patients were taking medications that were ineffective or harmful given their particular type of Dementia (there are many types of Dementia including Alzheimer’s, Lewy Bodies, Vascular, Frontotemporal, etc).

It was around this time that Rao came across two siloed data sets. One was the distribution of neurologists by state. The other was a data set of Dementia patients by state by year (including future years). She mashed the data together and what resulted was an eye-opening map of Dementia Deserts. The state of Wyoming, for example, was particularly ill-prepared to handle the expected number of Dementia patients. With very few Dementia specialists practicing in the state, patients residing there would likely have poorer outcomes due to lack of access. Rao’s paper has since been used by state agencies to lobby for more training and funding for neurological resources.

Rao, however, didn’t stop at simply identifying the problem. She wanted to do something about it and Neurocern was the result. After analyzing the problem she zeroed in on two specific issues: access to care and the lack of expert Dementia advice for patients. Here’s how the system works:

  • Patients and/or family build a brain profile in the application by answering questions (think a Myers-Briggs assessment but for your brain)
  • Based on the brain profile, the system comes up with recommendations for what can be done at home to keep seniors safe
  • Recommendations include:
    • How to gently convince someone to wash themselves (patients suffering from Dementia usually refuse to bathe)
    • How to help patients not to slip in the bathroom
    • The signs to look for if the patient needs insulin. Some Dementia patients pace the room which means they burn their sugar faster than normal and if they also have Diabetes they will need insulin sooner

“Neurocern is a cross between a neurologist and a social worker,” explains Rao. “It mirrors how my sessions with patients would go. For the first hour I would sit and listen to the family’s story. I’d use that information to build a profile. In the second hour I would review a care plan with the patient and their family. I would make sure they had things they could do at home to help reduce the impact of the Dementia. For example, if a patient suffers from, hallucinations, one of the care recommendations would be to cover mirrors in the home as they are triggers for hallucinations.”

Neurocern currently is capable of generating 5,000,000 care plans based on individual attributes discerned from the brain profile. Plans can be customized by the end-user.

The application has been piloted by a provider organization and Rao is currently in pilot discussions with a number of payers. “There is definitely a financial incentive to help patients better manage Dementia,” says Rao. “Dementia patients are 20% more likely to be readmitted and they have longer than average length of stays (ALOS). Dementia patients who have suffered a stroke have, on average, 38% higher costs. It’s the same story with Dementia + diabetes or other chronic conditions. On top of this is the fact that many healthcare organizations do not have the Dementia-trained staff to care for these patients. Neurocern can help to bridge that gap.”

Dementia is quickly becoming the leading cause of death around the world. It is already #1 in England and Wales and is the top cause of death for Australian women. In many other countries Dementia trails only heart disease. Without adequate training, resources and funding, our healthcare system runs the risk of being overwhelmed. We will need products like Neurocern and people like Rao to ensure the problem gets attention and that patients as well as providers have tools at their fingertips to help mitigate Dementia’s impact.

Rao will be presenting on a panel at next week’s AHIP conference – Innovate with Purpose: Technology Tools of Change alongside 3 other healthcare entrepreneurs.

HITExpo ThankTanks Spur Online Discussion on the Nature of EHRs, Innovation & Patient Experience

Posted on June 7, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Last week at the inaugural 2018 Health IT Expo (#HITExpo), we kicked things off with three ThinkTank sessions:

  1. Going Beyond EHRs –
  2. Practical Innovation –
  3. Communication & Patient Engagement –

These ThinkTanks were live-streamed via YouTube and were meant to engage members of the #HITMC, #HITsm, #hcldr and other online communities who could not be with us in person in New Orleans. Looking back over the tweets I believe it would be safe to say: mission accomplished.

The online discussion around the ThinkTanks was very rich and involved many different perspectives. During ThinkTank 1 Jim Tate had a keen bit of insight to share based on a comment made by panelist Shahid Shah of Netspective Media:

This was quickly followed by another interesting statement from Shah:

An interesting suggestion in ThinkThank 1 came from Dr. Fatima Paruk, Chief Medical Officer, Population Health at Allscripts – that it was never too late to get physicians involved in EHR optimization given that they are one of the main users of EHR systems. This was especially relevant given how much EHR frustration contributes to physician burnout.

Jeremy Coleman, one of the HITExpo’s social media ambassadors did an expert job at distilling a 5min during ThinkTank 1 into a single tweet:

The most interesting comment in ThinkTank 1 was made by Justin Campbell of Galen Healthcare. He suggested that one way to go beyond the EHR was to use the audit log information to identify workflow bottlenecks, training opportunities and UI improvements.

The second ThinkTank generated a spirited discussion amongst the panelists and with the online audience when the topic of blockchain technology was brought up. It started when John Lynn made the following statement:

Jared Jeffery from KLAS Research then immediately followed up his tweet with this humorous counter-point:

I agree with both John and Jared. The last thing we need is over-inflated hype around blockchain in healthcare. The technology itself holds promise but as an enabler of other technologies and processes. Simply slapping blockchain on existing processes is not going to yield the innovation healthcare needs. We need something more. The good news is that some pioneering organizations and HealthIT companies are experimenting with blockchain which will hopefully lead to incremental improvements.

Experimentation and the willingness to do something was on the mind of Jerry Cade – one of the panelist in ThinkTank 2. He had a poignant warning for all of us in healthcare:

In my opinion the most practical piece of advice of the day was shared by Shahid Shah during ThinkTank 2. It’s certainly something I’m going to pay more attention to in the future:

Your truly had the opportunity to moderate ThinkTank 3 and it was a blast. We had an amazing set of panelists that included nurses, HealthIT insiders, industry experts and the voice of the patient. It resulted in a robust discussion on the nature of patient experience.

Grace Jaime of Oneview Healthcare shared a keen insight which triggered a round of discussion on the need to clearly measure patient experience and communication effectiveness – If you can’t measure something, you can’t improve:

Grace Cordovano, professional patient advocate, then had this to add:

During ThinkTank 3 Sarah Bennight of Stericycle Communication Solutions made an interesting observation about patient advocacy and how it could be modeled after a legal precedent:

If you didn’t have the chance to catch the ThinkTanks live, I’d encourage you to watch the recordings (links above). The sessions were filled with valuable insights and practical advice that you can use right away. It was a lot of fun to participate in these ThinkTanks and I am definitely looking forward to doing more in the future.

In closing I think this tweet summed up the overall sentiment (from friend Ashley Dauwer at MEDITECH):

Bringing Their Valuable Experience to Healthcare Wasn’t Black & White for Zebra Technologies

Posted on May 30, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Earlier this year I wrote about the strong contingent of non-healthcare companies that exhibited at HIMSS18. Ever since then I have been curious to find out more about these companies – especially how they adopted their solutions to healthcare and how as outsiders they view the industry as a whole.

One of the companies that caught my eye was Zebra Technologies, a company that has a long history of providing mobility solutions for retail, manufacturing and government. In retail, for example, Zebra provides devices and software that consolidates inventory data from multiple source systems and delivers that date in real-time to sales associates. Not only does this result in better customer service, it also accelerates revenues for retailers. Zebra’s clients include retail giants Target and Walmart.

I recently sat down with Chris Sullivan, Global Healthcare Practice Lead at Zebra, to get his take on what the impact a company like Zebra could have in healthcare and what challenges there were bringing the company’s solutions into healthcare. Below is an abridged transcript of our conversation.

Is it an advantage or disadvantage being a healthcare “outsider”?

Being a company that has a long history outside of healthcare is both an advantage and a disadvantage.

The advantage is that we have tired and true solutions that work in other industries that in some ways are more demanding than what we see in healthcare. For example in auto manufacturing, tracking assets and inventory in the supply chain is extremely difficult. There aren’t nearly as many moving parts in a healthcare supply chain. Because we have solutions that can handle this type of complexity, it means we have an advantage when we take those solutions to healthcare.

Another advantage is our deep technical knowledge when it comes to mobility. We know what it takes to roll out a truly enterprise-class mobility solution and that gives us an advantage over companies that only have experience in the healthcare field.

The disadvantage is that as an organization it’s taken us time to build up our healthcare acumen and in the past we may have missed some of the nuances of healthcare. Just getting to know the acronyms and the terminology has taken time.

How did you address this gap?

As a company we had become more humble when it came to healthcare. We had to admit to ourselves that we had a lot to learn and that we had acknowledge that the way we need to do things a little differently in healthcare. There’s a very fine line between brining valuable expertise from other industries in a way that doesn’t override healthcare customers when they want to do something differently.

Our CEO and other senior leaders set the example. They recognized the gap and invested in bringing healthcare “insiders” onto the team. That’s why I’m here. They also invested in bringing the voice of healthcare customers into Zebra’s operations and processes. We now have a Customer Advisory Board where we vet product ideas and adjust based on their valuable feedback.

What was the most surprising thing that Zebra learned about Healthcare?

For the non-healthcare folks at Zebra, I think the complexity of healthcare workflows was a really big surprise. It’s a lot more complex than people realize. There are so many nuances and variables that just don’t exist in any other industry.

I think the magnitude of the opportunity in healthcare also took many by surprise. Not only is opportunity within the healthcare supply chain, but there is also plenty of opportunity for Zebra to help with care delivery.

Some were surprised to learn at how many barriers exist between patients and clinicians. There is just so much that gets in the way of caring for patients. There’s all the administration, documentation, collecting data from multiple sources and looking for assets. People became clinicians because they wanted to care for patients and somehow we’ve got them doing admin work.

What opportunities does Zebra see in healthcare?

We see an opportunity to help healthcare organizations improve their workflows. Specifically we see an opportunity for our technologies to eliminate unnecessary administrative and non-value-add steps for caregivers. By streamlining the workflow, quality would improve, the organization would become more efficient and thus require less resources, the patient experience would improve and care would be safer. There’s a lot of wasted time and resources in healthcare. We can help with that.

We also see an opportunity to bring true enterprise-level mobility solutions to healthcare. Up to this point, healthcare has had experience with smartphones and tablets, but those are consumer devices designed for individual consumers. They aren’t enterprise-class devices and they have inherent limitations in a healthcare setting. For example, they can’t be cleaned and disinfected very easily. They are difficult to secure. Managing upgrades is a nightmare. Plus smartphone cameras are not the same as industrial-strength barcode scanners which are common in enterprise devices.

There’s a KLAS report that does a great job at explaining how the inadequacies of the iPhone in healthcare has given rise to companies like Zebra.

Can you give me an example of enterprise-mobility work you have done in other industries that you are now applying to healthcare?

Sure. We have experience with many other verticals in addition to healthcare. One example would be the work we do for Ford Motor Company. As you know, Ford has a highly automated production line. It’s very expensive to have that line shut down. Zebra helps to tag all the equipment in those facilities so that production managers know exactly where their assets and inventory are located at all times. This is critical to ensuring that there is never a delay in getting the right asset to the right place at the right time.

We’re adopting this same know-how and associated technology to healthcare. It’s really vital to know where all your assets are in a hospital – from IV poles to beds to carts. The same applies to tracking high-dollar consumables like implantable devices. It’s really expensive to have doctors and nurses waiting around for the right equipment or the right medication to arrive – which is analogous to the work we do with Ford.

What advice would you give to other companies looking to enter healthcare?

Be humble. Don’t assume that because your solution worked in another industry that it can be plopped into healthcare as-is.

Play nice with others. There’s a big ecosystem in healthcare and you have to learn how to work together with those other players. Healthcare is a team sport.

Origin Story: Paul M Black, CEO of Allscripts – Deep Roots and Optimism in Healthcare

Posted on May 24, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

This is first in a new series of articles. Over the coming weeks and months I will be publishing the origin stories of interesting, inspiring people in healthcare. These men and women come from all walks of life. Some are titans in the industry, others are leading grass-roots efforts. All are making an impact on healthcare.

As a self-professed comic-book geek, I am fascinated by origin stories – the account or back-story that reveals how someone became who they are today. Origin stories add to the overall narrative and give reasons for a person’s intentions. Knowing someone’s origin stories can give clues to their future actions.

Kicking off this series is the origin story of Allscripts CEO Paul Black. Allscripts, based in Chicago, serves over 45,000 physician practices and 2,500 hospitals around the world with their EHR systems and other Healthcare IT solutions. The company has a rich history of mergers. Early on they merged with Misys and Eclipsys. More recently, the company has acquired McKesson’s Health IT business and Practice Fusion.

It is common knowledge that Mr. Black has a long history in healthcare. Prior to becoming CEO of Allscripts in December 2012, he spent 13 years as Chief Operating Office at Cerner (an Allscripts rival). He has also served as an advisor to healthcare companies through his work at New Mountain Capital and Genstar Capital.

What is not common knowledge is how far back Black’s history with healthcare actually goes. When he was just 5 years old, Black accidentally consumed weed poison that was in an unlabeled vial. Luckily his father, who was the Director of the Pharmacy Department at the local hospital took him to the VA emergency room right away. As a healthcare professional his father knew that the VA had just purchased an artificial kidney machine – the very device needed to treat this type of poisoning. Spoiler Alert: Black made a full recovery thanks to his father’s quick actions and the knowledgeable staff at the VA.

To understand how lucky Paul Black was, you have to remember that back then, there were no toxicologists, no poison control centers, no detailed chemical labels and very little knowledge of poison treatments. In fact, it wasn’t until 1953 that the first poison hotline was established in Chicago by Louis Gdalman R.Ph and Edward Press MD [source: Forging a Poison Prevention and Control System 2004].

Black’s poisoning incident led his father to establish an Iowa poisoning hotline so that people in his home state could find out what to do in a poisoning situation. His work eventually led to the creation of the Iowa Poison Information Control Center – an entity that is still saving lives today.

“My father was always working on ways to improve healthcare,” recalls Black. “He built a machine that would help ensure that the right medication would be administered to the right patient at the right time. It was basically a precursor to a Pyxis machine. He got involved in computers in the early stages and was always looking for ways to use systems (whether physical or software) to solve problems in healthcare.”

Clearly the apple did not fall far from the tree.

Early in his career, Black worked at IBM where he learned “a lot about systems, software and hardware.” But more importantly, it was his time at IBM that ignited his passion for healthcare.

“I just felt good whenever I worked with hospitals and healthcare clients,” explains Black. “It was clear that working with them had a direct impact on care and on individuals in their care.”

Black moved on from IBM and joined Cerner, then an up-and-coming healthcare systems maker. There, he progressed steadily through the ranks until ultimately becoming Chief Operating Officer in 2005. Black retired from Cerner in 2007 and served in a number of advisory/board positions until he was named CEO of Allscripts in 2012.

I asked Black why he chooses to stay in healthcare.

“It’s pretty simple actually. We aren’t done yet,” states Black. “My grandfather was born in 1888 and during his lifetime we went from horse-and-buggy on dirt roads to a full interstate system with fast cars and a railroad system with fast trains. We also went from having to read your news in a newspaper to wireless radio. He even saw us land on the moon. That was an incredible amount of progress for a single lifetime. I would argue that in my lifetime we are going to see a similar leap with just as many innovations, discoveries, and life saving technologies. That’s why I stay. Healthcare is going to be a fascinating industry for the next 20+ years. Plus there aren’t many industries where you get to help the people that save lives.”

Black went on to say that this is a time in healthcare when strong leadership will be required to ensure we make the right decisions for the benefit of the many vs the few. He pointed at genomic testing as an example. Even though the cost of sequencing continues to drop, access to this type of technology and access to clinicians knowledgeable on how to interpret the results is not universal.

Access to care is a cornerstone of Black’s vision of a perfect healthcare system, something I asked him to describe during our conversation: “My perfect healthcare future is one where everyone has access to healthcare, not just people of means. It’s one where a payment mechanism has been figured out whereby a certain level of access is guaranteed as is a certain level of prevention.”

Black went on to say that this vision is not as far fetched as it may first sound: “My view is that there is enough money already in the healthcare system today to make this happen. If you add the dollars spent by every single player in the healthcare industry – governments, employers, patients, etc – it’s more than enough. We are at 18% GDP. It’s just not being spent efficiently.”

To reach his vision, Black feels we need to build a healthcare system where: “We get the diagnosis right the first time, there is no delay in treatment and there is active involvement from patients in their health.” The latter being the toughest challenge – motivating the average person to exercise more, eat better and make healthier lifestyle choices.

“We have to make it cool to be healthy,” says Black. “In fact we need the healthy equivalent of the Marlboro Man, which I know is an ironic and strange thing to say. But back in the day, EVERYONE wanted to be the Marlboro Man. He was what young men aspired to be like. We need the healthy equivalent to help motivate people to be more engaged in health.”

It is not surprising that Black sees Allscripts playing a significant role in making healthcare more efficient and effective. “Allscripts definitely has a role to play,” explained Black. “We will play that role by staying relevant in the healthcare industry. We have our core EHR products, but we also have four other product lines that are actually EHR-agnostic. We have our population health platform, dbMotion. We have our post-acute system, Netsmart. We have our precision medicine platform, 2bPrecise. And finally we have our consumer platform, FollowMyHealth. We will continue to push aggressively in these markets through innovation and acquisition to provide our clients with the solutions THEY NEED to deliver better care to patients.”

Allscript’s latest acquisition certainly fits with this acquire-functionality-that-clients-want strategy. On May 18th, the company acquired HealthGrid – a communication platform that delivers reminders, alerts and educational materials to patients via phone, text, and other electronic means. This functionality will be rolled into Allscript’s FollowMyHealth product line.

“I feel it’s our duty and obligation to automate the healthcare ‘shop floor’,” declares Black. “The groundwork had been laid with EHRs, but now it’s time to streamline workflows and leverage the data within these systems. We need to reduce the ‘shouting’ in healthcare (too many alarms). We need to improve User Interfaces so systems are easier to use. We need to reduce the documentation requirements on clinicians so they can go back to taking care of patients vs being data entry clerks. Computers should work for us, not the other way around.”

Reflecting on Black’s origin story you can see the thread of hope and optimism woven throughout. From his first (and positive) encounter with the healthcare system when he was 5 years old to watching his father use computers/machinery to try and improve patient care to the positive feelings he had while working with hospital clients at IBM – every experience brought him closer and closer to healthcare until he became part of the industry through his position at Cerner.

It gives me hope that an industry leader like Paul Black is optimistic about the future of healthcare. It’s exciting to learn that he is not just saying the right words, he is putting energy and investment behind them. It will be interesting to see how Allscripts will continue to “remain relevant” and be agile in the years ahead.